Provider Demographics
NPI:1467664755
Name:KILGORE, JOLEY DIANNA II
Entity Type:Individual
Prefix:MRS
First Name:JOLEY
Middle Name:DIANNA
Last Name:KILGORE
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10610 WATERVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-8486
Mailing Address - Country:US
Mailing Address - Phone:214-202-7258
Mailing Address - Fax:
Practice Address - Street 1:2822 WIMBLEDON CT
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-6601
Practice Address - Country:US
Practice Address - Phone:972-278-9727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker